sons reaction today

[mdcoles1]

My 16 yr old son has had 2 allergic reactions in the past 5 months...both times swelling of lips, eyes and throat (he desribes a persistent cough and difficulty swallowing). Both times at school and had epi pen adminstered, after benadryl. He has been peanut positve since age 4, but we had gone 11 years with any type of reaction.

The first time was in the morning, after having orange juice and strawberry poptart-kellogs. Today incident occured right after lunch. He had brown bagged it and had turkey & cheese sub, poweraide, combos, a tangerine and a cherry nutrigrain bar. All items he has eaten numerous times except the tangerine. He said as soon as he put that in his mouth he felt a tingling,numb feeling and only ate 2 slices. but is was consumed immediately after the other food.

He was re-test in Dec. for the nut allergy and the verbal report was "his allergy levels had decreased from his earlier tests". We assumed it was some type of cross contaiminatin with the pop tart.

What should I do next...we are scheduled to see allergist next week, and I will ask that he be tested for cherry, strawberry, soy and tangerine.

Any suggestions, ideas would be appreciated. It is very troubling to think he has developed some type of new allergy.

[momma2boys]

Hello, sorry to hear about the reactions, and I hope he is ok now!  Have you read about OAS (oral allergy syndrome)?    Sounds like it is likely the citrus bothering him.  Does he have pollen allergies?

http://en.wikipedia.org/wiki/Oral_allergy_syndrome

[CMdeux]

I agree- seems very suspicious that both events involved the consumption of citrus. 

We have a number of members who have had the experience of an OAS trigger that eventually causes systemic reactions.  Sorry that he seems to have joined the club.   

I hope that your doc can help you figure out exactly what happened so that it doesn't happen again! 

[marian coles]

the one thing I find odd when thinking about the oral allergy syndrome is that he drinks oj every day...without any issue. 

It seems these things are never "obvious" and easy to get to the bottom of....

[momma2boys]

I used to drink citrus green tea every day, but certain days of the year I get hives in my mouth when I do, so I had to stop.  As a child I ate bananas every day, as a teen/adult, symptoms started, oral at first, eventually ended up anaph.  It can happen that way. 

[CMdeux]

Well, with that additional info, then, I'd look at environment as a possible factor.  You say that both reactions were at school.

I'd see what else was in common, then.

Same day of the week?  Same 'rotation' in the school menu?  Same friends seated in the same way?  Maybe it was a situation set up by cross-contamination both times?

[marian coles]

all good input...as for the school it is where both reactions took place, but different times (1 1st thing in morning; other after lunch) and two different locations, people etc. and when you consider how often he is at school that really makes it seem like the least likely connection.  Remember its HS, not elemetary where everything would be the same (classroom, people, etc).

the first reaction --I had bought an off brand of fortified oj (with pulp ?)...never have bought that one again; and I immediately dumped it after that reaction. so does pulp have more citrus?

So, my common dominators are:

Kelloggs--makes both nutrigrain bars and pop tarts

I really appreciate all thoughts and input....

Citrus--off brand of oj and tangerine

School

Cherry & strawberry--not flavors we eat as often

[CMdeux]

Is there a breakfast program at the school?  Might even be early morning-- so before your DS gets there.

That would make both reactions "after food service at school" (though I know that your son wasn't eating anything provided by them).

I'm just wondering if there was anything unique about the school environment on those two days.

Might take some sleuthing on your part and some phone calls-- try home ec, food service, and the science departments.

Here's why I wonder--

It's not uncommon to do "calorimetry" in physics or chemistry using a peanut or other very small bit of food.  In such an experiment, the food item is effectively vaporized via heating.  This would put a LOT of peanut protein into the air in the vicinity.

The morning one might've been the instructor doing a run-through, and the after-lunch one when the class did it (or saw it demonstrated).

KWIM?  I'm sure that food service and home ec are obvious sources in similar fashion (peanut satay, stir fry, etc.)

My own PA DD is almost 13, and she's drunk ALL kinds of orange juice over the years without ever having a problem (and she's really reactive, and has reacted to a lot of things on shared lines over the years)... 

the only exceptions that we make are "smoothy" type places that add protein powders to drinks, and "natural" juice companies like Odwalla. 

When I investigated a near-fatal anaphylaxis incident when she was two, I made phone call after phone call about orange juice and learned...

most of the plain/cheap stuff in the cartons and freezer section is impeccably safe.


Ohhhh-- and how close together in time was the second reaction to the first?  In the wake of anaphylaxis, it can take weeks for the immune system to become less trigger-happy again.  So a trace exposure that otherwise wouldn't have bothered him may have resulted in the second reaction.   You say "months" though, so that probably isn't it.

re: Poptarts... hmmm...

well, I (mostly) trust Kellogg's labeling practices for peanut and treenuts.  Keebler/Sunshine is better... but Kellogg's is right up there with General Mills.  Better than Kraft, certainly, about divulging shared processing.

As for the poptarts, was this a new package?  Has he eaten from it since/before?  That's not definitive, by any means-- but you could certainly call Kellogg's with the UPC code on the box and find out whether or not they are run on shared lines at all, or if there is a possibility of cross-contamination elsewhere.